Provider Demographics
NPI:1588707921
Name:JAMES A. KOUBA, D.D.S., P.C.
Entity type:Organization
Organization Name:JAMES A. KOUBA, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOUBA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:641-664-1121
Mailing Address - Street 1:107 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52537-1519
Mailing Address - Country:US
Mailing Address - Phone:641-664-1121
Mailing Address - Fax:641-664-2107
Practice Address - Street 1:107 S PINE ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:IA
Practice Address - Zip Code:52537-1519
Practice Address - Country:US
Practice Address - Phone:641-664-1121
Practice Address - Fax:641-664-2107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA061381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0128389Medicaid